Individual provider Active NPI

Cody Smouse, O.D.

  • Optometrist
  • Charleston, SC
National Provider Identifier
1770845489
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1704 Issued in SC
Practice address
112 Rutledge Ave
Charleston, SC 29401-1333
Phone
(843) 577-2674
NPI assigned
Jun 10, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1704 SC Primary

Addresses

Primary practice location

112 Rutledge Ave
Charleston, SC 29401-1333

Mailing address

894 Wynford CT
Mount Pleasant, SC 29464-9785
Phone (724) 689-5073

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140502000856 SC Practitioner - Optometry 4082847736 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

112 Rutledge Ave
Suite a
Charleston, SC 29401-1333
Phone (843) 577-2674

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
CRS Eyecare Services, Inc. CurrentSince Jan 1, 2018 Accepting new patients

Locations

112 Rutledge Ave
Charleston, SC 29401
Phone (843) 577-2674

112 Rutledge Ave
Ste A
Charleston, SC 29401
Phone (800) 410-4663

217 Calhoun St
Ste 1
Charleston, SC 29401
Phone (843) 480-2273

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420588800000",
    "number": "1770845489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "894 WYNFORD CT",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294649785",
            "telephone_number": "724-689-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 RUTLEDGE AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294011333",
            "telephone_number": "843-577-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMOUSE",
        "first_name": "CODY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-10",
        "last_updated": "2015-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.